AB1486 ASSESSMENT OF GLUCOCORTICOID-RELATED ADVERSE EVENTS BY THE GLUCOCORTICOID TOXICITY INDEX (GTI) IN RHEUMATIC PATIENTS
Authors: M. Bahap, E. Duran, A. B. Ekincioğlu, O. Karadag
Journal: Annals of the Rheumatic Diseases (2022)

Background Glucocorticoids (GCs) remain the mainstay treatment for several autoimmune and inflammatory diseases however, its long-term or high-dose usage also has many potential side effects. The glucocorticoid toxicity index (GTI) is a novel global monitoring tool (1) developed to systematically assess glucocorticoid-associated morbidity. Objectives To evaluate GC toxicity by using GTI in patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and vasculitis receiving glucocorticoids. Methods This descriptive, cross-sectional study included patients who were admitted to the rheumatology clinic between January 2021 and December 2021, were diagnosed with RA, SLE or vasculitis and treated with GCs. A single measurement of GC toxicity was performed using the GTI for each patient. Baseline GTI consists of twelve domains that related to commonly recognized adverse events that result of cumulative GCs exposure: body mass index (BMI), glucose metabolism, blood pressure, lipids, GC-induced myopathy, bone mineral density, skin toxicity, neuropsychiatric effects, infection, ocular, gastrointestinal and endocrine toxicity. The total GTI score ranges from 0 to 538 depending on the increase in toxicity burden. Results The study included 85 patients (55.3% male) with a mean age of 47.5 (±16.0) years (Table 1). Twenty (23.5%) patients had BMI values ≥30 kg/m2 and 63% of the patients were either hypertensive or receiving medications for hypertension. While HbA1c was ≥5.7% in 30 (35.3%) patients, 17 (20.0%) patients had glycated hemoglobin (HbA1c) value of ≥5.7% despite antidiabetic medication. Low density lipoprotein cholesterol (LDL-C) value of 33 (39%) patients was not on target. The median (IQR) GTI score of the study patients was 73 (81.5). Only 10 patients had a score of 0 in the GTI assessment. GTI scores were not correlated with the cumulative steroid doses (r=0.145, p=0.198) however, age was strongly associated with GTI scores (r=0.605, p&lt;0.001). Table 1. Demographics, disease characteristics, and glucocorticoid toxicities of the patients Characteristic ¶ All patients (n=85 ) RA (n=21 ) SLE (n=14 ) Vasculitis* (n=50 ) Age (years), mean (±SD) 47.3 (±17.2) 36.4 (±11.0) 50.6 (±15.5) Duration of disease (months) 12 (12.5) 16 (17.8) 14 (13.3) Damage and activity indices DAS-28=2.66 (2.1) SLEDAI=4.0 (6.5) BVAS**=0 (1.0) HAQ=0.07 (0.4) SLICC=0 (1.5) VDI=1.0 (1.0) Cumulative methylprednisolone dose (mg) 1458 (1496.9) 4646 (9053.5) 5604 (5281.5) GTI toxicity domain, n (%) 9 (42.8) 6 (42.8) 24 (48.0) ✓ BMI ≥27 kg/m 2 8 (38.1) 6 (42.9) 33 (68.8) ✓ HbA1c ≥5.7% 7 (33.3) 4 (28.6) 26 (53.0) ✓ Blood pressure &gt;120/85 6 (28.5) 2 (14.2) 25 (51.0) ✓ LDL-C &gt;target 4 (20.0) 0 11 (24.5) ✓Osteoporosis 2 (10.0) 2 (14.3) 13 (26.5) ✓ Skin toxicity 2 (10.0) 3 (21.4) 8 (16.3) ✓ Neuropsychiatric toxicity 2 (10.0) 0 6 (12.2) ✓ Ocular toxicity 2 (10.0) 0 5 (10.0) ✓ Gastrointestinal toxicity GTI score 65 (104.5) 44 (48.0) 87 (76) ¶ n (%), if otherwise specified; median (IQR) for numeric values other than age GTI: Glucocorticoid toxicity index, RA: Rheumatoid arthritis, SLE: Systemic lupus erythematosus, BMI: Body mass index, HbA1c: Glycated hemoglobin, LDL-C: Low density lipoprotein cholesterol *Vasculitis patients include ANCA-associated vasculitis, Giant cell arteritis, Takayasu arteritis, Behcet’s syndrome, Igg4-related disease, Polymyalgia rheumatica and Leukocytoplastic vasculitis patients. ***BVAS value given only for ANCA-associated vasculitis (n=19) Conclusion Our study revealed the iceberg of glucocorticoid toxicities in patients with rheumatic disease. Usage of GTI would help management of these possible toxicities. Therefore, it is important to assess GC toxicity at regular intervals during ongoing treatment in order to detect potential differences in the GTI scores. References [1]Miloslavsky EM, Naden RP, Bijlsma JW, Brogan PA, Brown ES, Brunetta P, et al. Development of a Glucocorticoid Toxicity Index (GTI) using multicriteria decision analysis. Ann Rheum Dis. 2017;76(3):543-6. Disclosure of Interests None declared